Patients also say they want to awake and conscious when their pain is managed. The issue is that there are not many U.S. physicians and nurses who are certified to extend palliative care. There are only 33 physicians and only 41 nurses for every 10,000 patients (Peres).
The hospice movement has been changing the face of care for people at the end-of-life stage (Radulovic 2004). Hospices have been providing options and choices to these patients for the last three decades. The hospice movement began in the UK but spread to America in response to the need for more compassionate care for the dying and terminally ill. A hospice is not a place but a concept of palliative and support services for the terminally ill to be cared for primarily at home. A home can be the patient's residence or that of a loved one, a long-term care facility. It provides the specific care these patients demand. Almost 90% of adults surveyed expressed the preference to be cared for by their own family if they were terminally ill or were in the last six months of life. The American public's priorities at this time include home-based care, patient control and choices on services available to them, emotional and spiritual support for them and their families, pain control according to their wishes, and freedom from financial cares. Congress put the Medicare Hospice Benefit in place in 1982. It has enabled millions of Americans to receive end-of-life care. More than 96% of U.S. hospices are Medicare certified and more than 80.9% of Medicare beneficiaries made claims on it as their payment source in 2002. Most private insurance plans, managed care providers and Medicaid in most states cover hospice services. But as the population ages and life expectancy increases, more sophisticated and costlier medical interventions have been required for health care needs. Today's hospices address a wide range of terminal and end-of-life disease states and palliative care services. In 2002, 50.5% of admissions were cancer patients. Hospices now also serve those with end-stage heart, kidney and liver diseases, as well as dementia, lung disease, HIV / AIDS and other severe conditions. Treatments associated with curative care, such as chemotherapy and radiation, are being used to palliate end-of-life care (Radulovic).
Opinion
The elderly and terminally ill should be admitted to ICUs only when they can strictly benefit from the special care made available there and for a restrictive period only. In the final days and weeks of their lives, they should be moved to a more comfortable, cheaper, less restrictive and personal environments like a home or a hospice. Medical professionals should be called in to administer special services and medications the patient may need.
Bibliography
Bone, Roger C. Analysis of Indications for Intensive Care Unit Admissions. Chest:. American College of Chest Physicians, December 1993
Earl, C et al. "Rise in Aggressive Treatment." Trends in the Aggressiveness of Cancer Care Near the End of Life. Journal of Clinical Oncology:. Springhouse Corporation, 2007
Peres, Judith. U.S. End-of-Life Gets Passing Grade. Health Care Benchmarks and Quality Improvement: American Health Consultants, Inc., 2003
Radulovic, Jan.W.…
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